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J Cardiovasc Magn Reson. 2017 Sep 1;19(1):66. doi: 10.1186/s12968-017-0380-4.

Feature tracking CMR reveals abnormal strain in preclinical arrhythmogenic right ventricular dysplasia/ cardiomyopathy: a multisoftware feasibility and clinical implementation study.

Author information

1
Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA.
2
Department of Medicine, Division of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands.
3
Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Headington, Oxford, UK.
4
Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, MA, USA.
5
Department of Radiology, Johns Hopkins Hospital, Baltimore, MD, USA.
6
Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD, USA.
7
Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.
8
Department of Medicine, Division of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands. ariele@umcutrecht.nl.
9
Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD, USA. ariele@umcutrecht.nl.
10
Netherlands Heart Institute, Utrecht, the Netherlands. ariele@umcutrecht.nl.

Abstract

BACKGROUND:

Regional right ventricular (RV) dysfunction is the hallmark of Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C), but is currently only qualitatively evaluated in the clinical setting. Feature Tracking Cardiovascular Magnetic Resonance (FT-CMR) is a novel quantitative method that uses cine CMR to calculate strain values. However, most prior FT-CMR studies in ARVD/C have focused on global RV strain using different software methods, complicating implementation of FT-CMR in clinical practice. We aimed to assess the clinical value of global and regional strain using FT-CMR in ARVD/C and to determine differences between commercially available FT-CMR software packages.

METHODS:

We analyzed cine CMR images of 110 subjects (39 overt ARVD/C [mutation+/phenotype+], 40 preclinical ARVD/C [mutation+/phenotype-] and 31 control) for global and regional (subtricuspid, anterior, apical) RV strain in the horizontal longitudinal axis using four FT-CMR software methods (Multimodality Tissue Tracking, TomTec, Medis and Circle Cardiovascular Imaging). Intersoftware agreement was assessed using Bland Altman plots.

RESULTS:

For global strain, all methods showed reduced strain in overt ARVD/C patients compared to control subjects (p < 0.041), whereas none distinguished preclinical from control subjects (p > 0.275). For regional strain, overt ARVD/C patients showed reduced strain compared to control subjects in all segments which reached statistical significance in the subtricuspid region for all software methods (p < 0.037), in the anterior wall for two methods (p < 0.005) and in the apex for one method (p = 0.012). Preclinical subjects showed abnormal subtricuspid strain compared to control subjects using one of the software methods (p = 0.009). Agreement between software methods for absolute strain values was low (Intraclass Correlation Coefficient = 0.373).

CONCLUSIONS:

Despite large intersoftware variability of FT-CMR derived strain values, all four software methods distinguished overt ARVD/C patients from control subjects by both global and subtricuspid strain values. In the subtricuspid region, one software package distinguished preclinical from control subjects, suggesting the potential to identify early ARVD/C prior to overt disease expression.

KEYWORDS:

Arrhythmogenic right ventricular dysplasia/Cardiomyopathy; Feature tracking cardiac magnetic resonance imaging; Global myocardial strain; Regional myocardial strain; Software comparison study

PMID:
28863780
PMCID:
PMC5581480
DOI:
10.1186/s12968-017-0380-4
[Indexed for MEDLINE]
Free PMC Article

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